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NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.
Michael S Kavic1, Brian Mirza, Walter Horne
1St. Elizabeth Health Center, NEOUCOM for HMHP, Department of Surgery, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44501-1790, USA. michael_kavic@hmis.org
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|April 12, 2008
Summary
Natural orifice translumenal endoscopic surgery (NOTES) is feasible in animal models. This study in swine demonstrated the value of laboratory-based NOTES investigation for surgical residency training, highlighting the need for multidisciplinary teams and specialized facilities.
Area of Science:
- Minimally invasive surgery
- Surgical innovation
- Endoscopic procedures
Background:
- Natural orifice translumenal endoscopic surgery (NOTES) emerged in 2004, with subsequent research in animal models.
- This project aimed to study NOTES intervention in a controlled laboratory setting using swine models.
- The study integrated expertise from experienced surgeons, a veterinarian, and residents, with IACUC approval.
Purpose of the Study:
- To investigate the feasibility and safety of Natural orifice translumenal endoscopic surgery (NOTES) in a laboratory environment.
- To develop and refine NOTES techniques for integration into a surgical residency training program.
- To assess the learning curve and necessary resources for implementing NOTES procedures.
Main Methods:
- Five laboratory sessions were conducted using swine models (37-43.1 kg).
- Standardized anesthesia and euthanasia protocols were followed.
- Equipment included a Fujinon EVE endoscope, adapted overtube, standard endoscopic instruments, and laparoscopic visualization.
Main Results:
- Natural orifice translumenal endoscopic surgery (NOTES) intervention was found to be feasible in the animal model.
- The investigation provided valuable insights into the potential applications and challenges of NOTES.
Conclusions:
- Laboratory-based NOTES investigation using animal models is valuable for training programs.
- A steep learning curve necessitates multidisciplinary teams with advanced endoscopic and laparoscopic skills.
- Availability of animal laboratory facilities and prior IRB approval are crucial for human NOTES implementation.
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